Neurology & Pain Management Coding Alert

Question: Can we bill 95810 and 95811 on the same day for continuous positive airway pressure (CPAP) and nonCPAP sleep study testing using modifier -59 (distinct procedural service)? If the sleep study testing is performed first with no CPAP and then the test is rerun with CPAP, how would this be coded correctly?

New Mexico Subscriber

Answer: Tammy Chidester, CPC, billing supervisor at Upshur Medical Management Services Inc., in Buckhannon, W.Va., says that according to the Correct Coding Initiative, CPT codes 95810 (polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist) and 95811 (polysomnography; sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) may not be billed on the same date. There are no applicable modifiers that will bypass the edits and allow them to be billed together. One code will always be denied.

Codes 95810 and 95811 require at least six hours of sleep. It is unlikely that two six-hour sessions would be done on the same day, making it improbable that both codes would be billed. Any time that less than six hours of testing is completed, modifier -52 (reduced services) should be used. If a full six-hour study is conducted with no CPAP, then a few hours of additional testing with the CPAP is performed, you might consider appending modifier -22 (unusual procedural services) to indicate that the service provided is greater than that usually required for the listed procedure.